JOB SUMMARY: Responsible for ensuring that we are compliant with medical necessity guidelines.

DUTIES AND RESPONSIBILITIES: This job description is not intended, nor should it be construed, to be an all-inclusive list of responsibilities, duties, skills or working conditions associated with the job. It is intended to be a general description of the essential duties and requirements common to positions of this type and may be subject to change. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Review claims for medical necessity compliance/correction
• Obtain facility medical records to assist in claim review
• Review and prepare Air Med appeals
• Review and prepare courtesy Medicare Appeals
• Handle inbound calls
• Ensures accuracy of demographic information
• Other responsibilities, as assigned

QUALIFICATIONS:

• Preferred 3 years of Medicare, Medicaid and/or Insurance including ICD-10 coding.
• Basic/Paramedic Clinical Experience Preferred
• Intermediate computer skills 
• Problem solving abilities including procedure improvement 
• Excellent communication and customer relation skills
• Familiarity with the Centers for Medicare & Medicaid Services regulations (ambulance)
• Ability to adhere to productivity goals and departmental guidelines
• Demonstrate a strong work ethic and work independently 
• Possess strong organizational skills
• Understands HIPAA and Red Flag guidelines
• High school education or equivalent

TRAINING REQUIREMENTS:

• Orientation to job requirements
• 6 months in office training with exit exams
• Work from home rotation optional after successful training completion